Members of the Hernandez family gather in front of the remains of Carla Hernandez’ home in San Agustin, El Salvador, Dec. 14, 2009. November flooding and mudslides claimed more than 100 lives and displaced many more residents. A combined Medical Civil Action Program (MEDCAP) coordinated between U.S. and El Salvadoran officials is providing free medical care to residents of affected areas today and tomorrow. A team of 30 from Joint Task Force-Bravo, based in Honduras, is working with the Salvadoran Ministry of Health and others to provide the care. (U.S. Air Force photo/Tech. Sgt. Mike Hammond)

A baby waits as her mother attends a preventive medicine class prior to receiving vitamins, soap and medical care during a Medical Civil Action Program (MEDCAP) conducted by the Salvadoran Ministry of Health and Joint Task Force-Bravo, in San Agustin, El Salvador, Dec. 14, 2009. The MEDCAP, which continues tomorrow in El Achiotal, El Salvador, comes as a follow-up to earlier medical and relief efforts coordinated with the Ministry of Health, U.S. Southern Command, and the U.S. Embassy and Military Group in El Salvador. November flooding and mudslides killed more than 100 people and displaced many more in the area. (U.S. Air Force photo/Tech. Sgt. Mike Hammond)

U.S. Army Maj. David Haight (center) and a translator from the El Salvadoran military evaluate an elderly woman seeking treatment during a Medical Civil Action Program (MEDCAP) conducted by the Salvadoran Ministry of Health and Joint Task Force-Bravo, in San Agustin, El Salvador, Dec. 14, 2009. The MEDCAP, which continues tomorrow in El Achiotal, El Salvador, comes as a follow-up to earlier medical and relief efforts coordinated with the Ministry of Health, U.S. Southern Command, and the U.S. Embassy and Military Group in El Salvador. November flooding and mudslides killed more than 100 people and displaced many more in the area. (U.S. Air Force photo/Tech. Sgt. Mike Hammond)

A woman washes clothes in Lake Ilotongo, near San Agustin, El Salvador, Dec. 14, 2009. Residents of San Agustin and other areas were heavily affected by flooding and mudslides in November. A combined Medical Civil Action Program (MEDCAP) coordinated between U.S. and El Salvadoran officials is providing free medical care to residents of affected areas today and tomorrow. A team of 30 from Joint Task Force-Bravo, based in Honduras, is working with the Salvadoran Ministry of Health and others to provide the care. (U.S. Air Force photo/Tech. Sgt. Mike Hammond)

ILOPONGO, El Salvador --
For Nieto Cruz-Hernandez and his family, the morning of Nov. 8 will never be forgotten.

After a low pressure system brought torrential downpours to much of El Salvador, the Arenal River ran dangerously high as it flowed through Mr. Hernandez' small city of San Agustin. His sister-in-law, Carla Santos-Hernandez, her children, and other family members gathered to spend the night of Nov. 7 at Mr. Hernandez' house - which was on higher ground than their own places.

As the family slept in relative safety, all hell broke loose in the lower-lying parts of town.
A wall of water roared down the riverbed, pushing with it a crushing ooze of mud and debris - a deadly mix that consumed anything and everything in its path.

At around 8 a.m. the following morning, the Hernandez family ventured out to see what had happened overnight.

Death and Destruction

Carla Hernandez and her family lived in a small cinderblock house - much like those of the other residents of the farming and fishing community. But the wreck she came back to was nothing like the home she left. The roof was collapsed, walls were either missing completely or in pieces, and mud was piled up several feet high all around and through the home.

Her neighbor, another brother of Nieto Hernandez, fared even worse. Where his home once stood, nothing but small blocks of concrete and strands of rebar remained among the mud. Just one block or so away, three residents were missing ... along with their homes. Only one of them has been found -- dead in the nearby Lake Ilopongo.

A Continuing Partnership

Fortunately for stricken communities like San Agustin, many in El Salvador and from other friendly nations including the United States sprang into action upon hearing of the destruction. The Salvadoran government teamed up with U.S. Southern Command, Joint Task Force-Bravo, the United States Agency for International Development and a number of non-governmental aid organizations to begin a multi-faceted relief effort.

The desire to help those in need is what drove an initial Medical Civil Action Program between Joint Task Force Bravo, based at Soto Cano Air Base, Honduras, and the Salvadoran Ministry of Health from Nov. 21-24. Nearly 3,000 patients received medical care, prescription and over-the-counter medication, immunizations and counseling.

Today, a follow-up MEDCAP began - starting in San Agustin and continuing tomorrow in the city of El Achiotal. In San Agustin, 445 patients were seen. They received preventive medicine education, medical and dental care, vitamins and medicine, and immunizations. Joint Task Force-Bravo used three helicopters and crews, plus 30 medical and other personnel in the effort. The Salvadoran Ministry of Health brought approximately 30 health care providers and workers, and the El Salvadoran military and police force used over 20 people to provide security at the site.

"We have focused our efforts here (in San Agustin) because it is one of the hardest-hit areas from the November flooding," said Dr. Ellen Awarenga de Duenas, the Ministry of Health coordinator for the Department of Cuscutlan, in which San Agustin falls. "We have sent help here before, but we didn't have enough to treat everyone in need. That's why with the additional providers and medicine we feel we may reach our goal of offering care to everyone affected."

In addition to treating common ailments such as upper respiratory illness, rashes and intestinal parasites, the MEDCAP also featured 4 Salvadoran psychologists available to diagnose and begin to treat patients with Post Traumatic Stress Disorder stemming from the disaster.

The Way Ahead

For the residents of San Agustin, there's plenty of work ahead in rebuilding their lives. Things improve daily - commercial equipment works steadily throughout the day removing dirt and debris still left from a month ago. But it's slow, tedious work coming back when you've lost everything.

Residents like the Hernandez family and others in these communities have suffered a great deal. But with every road plowed and every patient cared for, heartbreak slowly turns into hope.